Tamoxifen is making me crazy

Is effexor the only antidepressant to take? I have  heard horror stories of people trying to get off of it and that scares me! I also am tired of constantly being mad, not sleeping, crying, etc. If taking something will really make me feel better, then I am all for it! I see my onc on 4/21 so I hope to ask then.

D

Runner4life

Hi!   I started taking Tamoxifen about 6 weeks ago.  Things seem to be settling down for me.  I am a runner and lift weights.  I have always exercised at least 4 times a week for years actually decades.  I am still trying to recover from my bilateral mastectomy and SGAP repair, but at least I can run again.  I went to a Yoga class about 3 weeks ago because I was so tight from inactivity.  The one result I noticed the most from the Yoga was that it really helped me to relax and exercise muscles that have been neglected.   I did not feel as agitated, and my mood swings have begun to even out.  My family even noticed a big difference.  Running has always relaxed me and given me a natural positive high, but since I have been  post op it has been such a physical  challenge it did not give me the relaxation.  The yoga has been so soothing for me and given me time to pause.  I follow it up with a run, and I feel fantastic.  Might give it a try since you like to exercise.  

 Hope the SE will settle down for you!

Sunandsandgirl 

Effexor ALSO helps with hot flashes associated with meopause so it is one of the Anti depressants that is rountinely perscribed for BC woman.

Like I mentioned I take a low dose 75 mg and it helps me SO much. I wish I took it sooner than suffer. when it comes to weaning off....I will tackle that when it happens. Right now I am enjoying NOT being moody and emotional with all this BC crap.It is helping me "move on".

runner4life..

It's funny we are talking about sleep because the last 2 weeks have been rough. I don't fall asleep till 1 or 2 am and toss and turn. I have a perscription for Zoplicone these little blue pills. I plan on getting them tomorrow. They work wonders, I only use them when I'm desperate.My father who is 57, takes half a pill an hour b4 bed to help him stay asleep because he is a heavy teeth grinder and would wake up because of it.He has used it for 3 years to help.

and I thought it was me - LOL

I have been having the same issues - no sleep, weepy (I call it my moments) .... my doc gave me a script for clomazipam (SP?)... anyway, he let me try them for a week - they seem to help, I have to pic up another scrpit of them tomorrow. 

I've been on Tamoxifen for 2 1/2 years and take Effexor daily.  I don't think I could funtion without it.  I'm a very high strung person.  I also need a Xanax to calm me down for sleep.   It works so my doctors are all for it.  I'm looking forward to the day that I don't need any meds.

Good luck,

Nancy

Runner:

I thought I read a recent study that a low dose of tamoxifen was just as effective as 20 mgs.  I think they use 10 mgs. in Europe.  I am supposed to be on 20 but I was miserable on just the 10, practically suicidal, crying all the time, no way to live.  So I went off it for a week.  Ran into a neighbor the other night though who told me that my neighbor who died a couple of years ago went off her tamoxifen for the very same reason as me, her emotions are out of control so I'm back on it, but I'm sticking to the 10 mgs. for the time being, along with my alternative supplement DIM.

Hope you feel better.

Peeps

Here's a pretty comprehensive list of things not to take with Tamoxifen.

This is the html version of the file http://www.medicine.iupui.edu/clinpharm/COBRA/TamoxifenGuide.pdf.

References
1. Borges S et al. "Quantitative effect of CYP2D6 genotype and
inhibitors on tamoxifen metabolism: Implication for optimization of
breast cancer treatment." Clin Phamacol Ther. 2006 Jul;80(1):61-74.
2. Jin Y et al. "CYP2D6 genotype, antidepressant use, and ta-
moxifen metabolism during adjuvant breast cancer treatment." J Natl
Cancer Inst. 2005 Jan 5;97(1):30-9.
3. Goetz MP et al. "The impact of cytochrome P450 2D6 metabolism
in women receiving adjuvant tamoxifen." Breast Cancer Res Treat.
2007 Jan;101(1):113-21.
4. Gonzalez-Santiago S et al. "CYP2D6*4 polymorphism as blood
predictive biomarker of breast cancer relapse in patients receiving
adjuvant tamoxifen." ASCO Abstract 2007.
Website: WWW.Drug-Interactions.Com
The information presented on this card is intended as
general health information and as an educational tool. It
is not intended as medical advice. Only a physician,
pharmacist or other health care professional should ad-
vise a patient on the use of the medications prescribed.
©January 2008. Consortium on Breast Cancer Pharmacogenomics

Strong CYP2D6 Inhibitors
Generic Names
Brand Names
Fluoxetine
Prozac®
Paroxetine
Paxil®
Qunidine
Cardioquin®
Bupropion
Wellbutrin®

Moderate CYP2D6 Inhibitors
Generic Names
Brand Names
Duloxetine
Cymbalta®
Sertraline
Zoloft®
Diphenhydramine
Benadryl®
Thioridazine
Mellaril®
Amiodarone
Cordarone®
Trazodone
Cimetidine
Tagamet®

SSRIs and SNRIs that are not inhibitors
Generic Names
Brand Names
Venlavaxine
Effexor®
Citalopram
Celexa®
Escitalopram
Lexapro®

Drugs that inhibit CYP2D6 that
should be avoided while taking
tamoxifen
Drug Information - Tamoxifen citrate
(Nolvadex®), originally manufactured by
AstraZeneca (also available as a generic)
Tamoxifen is a medicine that is taken as a pill by mouth.
It is called a selective estrogen receptor modulator
(SERM) because it acts as a weak estrogen in some tis-
sues like bone but as a strong antagonist of the action of
estrogen in the breast. It has been FDA approved for the
treatment of both early and advanced estrogen receptor
positive breast cancer in pre- and post-menopausal
women and in men. Tamoxifen is also FDA approved
for the prevention of breast cancer in women that are at
high risk for breast cancer.
Dosing Information:
•
Metastatic breast cancer: 20 to 40 mg daily
•
Adjuvant treatment for breast cancer: 20 to 40 mg
daily for 5 years
•
Intraductal carcinoma in situ of breast, following
breast surgery and radiation, to reduce risk of invasive
disease: 20 mg daily for 5 years
•
Breast cancer, high-risk; prophylaxis: 20 mg daily
for 5 years
Disease Overview - Breast Cancer
Breast cancer is the most common and lethal cancer in
women. The National Cancer Institute estimates that
in 2007, 178,840 new cases of breast cancer will occur,
and that 40,460 women will die as a result of the dis-
ease. The lifetime risk of breast cancer for women in
the United States is approximately 1 in 8. Treatment
of breast cancer now involves a number of possible
drugs that are used after the radiation and chemother-
apy that are utilized immediately after surgical re-
moval of the tumor. In women who have estrogen and/
or progesterone receptor positive tumors that include
anti-estrogen therapies including tamoxifen, which is
an antagonist of the action of estrogen in the breast,
and the aromatase inhibitor class of drugs, which
lower the estrogen circulating in the body by blocking
the synthesis of estrogen by aromatase from andro-
gens in fat tissue. The aromatase inhibitors do not
work in women before the menopause, in whom most
estrogen is made in the ovaries, but tamoxifen is effec-
tive in both pre-and post-menopausal women.
According to the most recent National Cancer Com-
prehensive Network breast cancer clinical practice
guidelines, risk reduction therapy with tamoxifen,
either alone or in conjunction with surgery or radio-
therapy, is recommended for premenopausal and post-
menopausal patients with estrogen receptor positive
disease to prevent breast cancer recurrence. The NIH
Breast Cancer Prevention Trial showed that tamoxifen
given for 5 years reduces the risk of invasive breast
cancer by approximately 50% after 5 years of ta-
moxifen therapy.
The product labeling contains a black box warning for
serious and life-threatening events which include uter-
ine malignancies, stroke and pulmonary embolism in
patient with Ductal Carcinoma in Situ (DCIS) and
women at high risk for breast cancer. Data from the
largest trials conducted indicate that these events oc-
cur in 1 in every thousand women over 5 years of
treatment.
Drug interactions with tamoxifen are important be-
cause the drug is extensively converted to active me-
tabolites (breakdown products) in humans and these
metabolites may be responsible for many of the effects
of the drug. Since the main active metabolite is made
by an enzyme in the liver called cytochrome P450
2D6 (CYP2D6), drugs that powerfully block the activ-
ity of the enzyme may reduce the effects of tamoxifen.
Tamoxifen Metabolism Pathway
We have listed here drugs that are frequently co-
prescribed with tamoxifen that are powerful inhibitors of
the CYP2D6 enzyme that reduce the concentrations of
active metabolites substantially (Strong CYP2D6 Inhibi-
tors), and drugs that are less powerful, but still signifi-
cant inhibitors (Moderate CYP2D6 Inhibitors). Since
antidepressants are so frequently co-prescribed with
tamoxifen (up to 30% of patient in the US) we have spe-
cifically listed all the SSRI and SNRI antidepressants
that do not interfere with tamoxifen metabolism as well
as those that do.

Peppy-

Thanks so much for these references and accompanying lists.  I will take this to my family M.D. for reference because she has several breast cancer patients in her practice.  My oncologist only uses Effexor for her patients - we learned that at our Survivor's Orientation last year. This ia a great addition to my breast cancer file!

Runner4life - so sad to read your post - I had a break from tamoxifen after 2.5 months and am now back on it (7 months) and my depression has disappeared.  I still get gnarly and a little anxious but my quality of life is very much improved, and this is without taking the Effexor my Onc wrote out for me.  I hope the antidepressants and "holiday" off tam work for you like it did for me.

big hugs

Helena

(Ps. I'm a runner too)

Runner4Life,

I felt like you were describing my emotions exactly.  I have been on Tamoxifen since February. I started out ok with just a few hot flashes, but these last few weeks have been tough.  My running and exercise seemed to keep me in check for a few months.  The running still helps, but it does not prevent my mood swings like it did.   I have felt so sad and or angry.  The most simple and ridiculous things will make me cry.  I never cried before.  I think in the last 2 weeks I have cried for the 46 years I did not.  Keep us posted if you start back on the Tamoixfen.  I am still trying to hold on.  Good luck to you.  I hope the break will bring back the smiles and laughter.

sunandsandgirl 

Hi Everyone,

Thank you so much for sharing all of these experiences!  I too am feeling crazy emotionally, and definite soreness...achy knees and fatigue like symptoms.  I started tam about three weeks ago, after completing chemo and radiation.  I also have shoulder pain....has anyone else experienced that too?  It just feels like an achy-all-over feeling at times.  Definitely improves with rest but I feel like I have a hard time resting due to anxiety as well.

I have effexor that I have not started yet but may indeed do so after reading all of these posts.  Thanks again and I am so glad I logged back in too!!!!

Warmly,  Fiona